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Published on: October 20, 2017
First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations : Safety and Efficacy
Quentin Alias1, Grégoire Boulouis1,2, Thomas Blauwblomme3,4
1Pediatric Radiology, Necker Children Hospital, Paris, France.
Insights
Onyx embolization is a safe and effective first-line treatment for ruptured pediatric brain arteriovenous malformations (bAVM). This approach shows high obliteration rates, especially for lower-grade bAVMs, and is suitable for younger patients.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Endovascular Surgery
Background:
- Pediatric intracerebral hemorrhage (pICH) is often caused by brain arteriovenous malformations (bAVM).
- Embolization using Onyx for ruptured pediatric bAVMs is infrequently documented.
- Assessing Onyx embolization as a primary endovascular treatment for ruptured pediatric bAVMs is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of Onyx embolization.
- To determine its role as a first-line endovascular treatment for ruptured pediatric bAVMs.
Main Methods:
- Prospective registry and retrospective analysis of 29 children with ruptured bAVMs treated between 2013-2018.
- Data collected included clinical, demographic, procedural, and follow-up imaging details.
- Safety (morbidity, mortality) and efficacy (obliteration, rebleeding) were assessed.
Main Results:
- 29 children underwent 72 Onyx embolization sessions; 79% had deep-seated bAVMs.
- No systemic complications or persistent neurological deficits occurred.
- Complete obliteration rates varied by Spetzler Martin grade: 100% (I), 89% (II), 29% (III), 14% (IV-V).
Conclusions:
- Onyx embolization is a safe and effective initial treatment option for ruptured pediatric bAVMs within a sequential strategy.
- Age should not be a contraindication for considering Onyx embolization in pediatric patients.
- The study supports Onyx embolization as a viable first-line approach for this condition.
Purpose:
Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs.
Methods:
Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated.
Results:
In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1-12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1-3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV-V, respectively.
Conclusion:
It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.
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